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This information is about a chemotherapy treatment for bowel cancer called the Mayo regimen. It describes the drugs, how they are given and some of the possible side effects. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.
The Mayo regimen (named after the American hospital that started it) involves the drugs:
5FU and folinic acid are commonly used in the treatment of bowel cancer. It is important to know that the two drugs are often used together in different ways. This information is specifically about the Mayo regimen.
Mayo treatment can usually be given to you as a day patient. You will need to have a blood test before you start treatment – either on the same day, or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.
The nurse will then put a fine tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful, but it should not take long. Some people have their chemotherapy given through a thin plastic tube that is inserted under the skin into a vein near the collarbone (central line), or passed through a vein in their arm (PICC line). Your doctor or nurse will explain more about this to you.
You will be given an anti-sickness (anti-emetic) drug. This is usually given by injection through the cannula, central line or PICC line but may be given as tablets. The chemotherapy drugs are then given separately:
If you are having your treatment as a day patient you can then usually go home. You will be given a supply of anti-sickness drugs to take with you. As you will be coming back for more treatment during the next four days, your cannula (if you do not have a central line) may be left in place and will be securely taped.
Your doctor may use the word 'regimen' (eg the Mayo regimen) when talking about your chemotherapy. This means the plan or schedule of the particular treatment that you are receiving.
You will be given 5FU and folinic acid (as described) daily for five days. After this you will have a rest period with no chemotherapy for the next three weeks. This completes what is called a cycle of the chemotherapy treatment.
You will start the next cycle of your treatment after the rest period, which will be four weeks after your first injection. The treatment is usually given for six cycles over a period of six months. This makes up a course of treatment.
Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described below will not affect everyone who is having Mayo chemotherapy. We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you notice any effects that you think may be due to the drug, but which are not listed here, please let your nurse or doctor know.
Lowered resistance to infection Mayo chemotherapy can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straightaway if:
You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.
Bruising or bleeding Mayo chemotherapy can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.
Anaemia (low number of red blood cells) While having treatment with Mayo chemotherapy you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these effects are a problem.
Feeling sick (nausea) and being sick (vomiting) This is usually mild and your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. If the sickness is not controlled or if it continues, tell your doctor, who can prescribe other anti-sickness drugs that may be more effective. Some anti-sickness drugs may cause constipation. Let your doctor or nurse know if this is a problem.
Tiredness Many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is important to try to get as much rest as you need.
Hair loss Hair loss is rare with this treatment, but your hair may thin or occasionally be lost completely. If you do lose your hair, it will start to grow again once the treatment has stopped.
Sore mouth and ulcers. Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection.
Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.
Diarrhoea This can usually be easily controlled with medicine but let your doctor know if it is severe or if it continues. If you have diarrhoea it is important to drink as many as 2–3 litres of liquid a day.
Gritty eyes and blurred vision If this happens let your doctor know. They can prescribe some soothing eye drops.
Skin changes Your skin may darken but this will slowly return to normal a few months after the treatment has finished. During treatment, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily. You can still go out in the sun, but always wear a high protection-factor suncream and cover up with clothes. Your skin may also become itchy and dry. Your doctor can prescribe treatment to help to reduce this.
Always let your doctor or nurse know about any side effects that you have. There are usually ways in which they can be controlled or improved.
Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs which thin the blood. Your doctor or nurse can give you more information.
Other medicines Some other medicines can be harmful when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Fertility Your ability to become pregnant or father a child may be affected by this treatment. It is important to discuss fertility with your doctor before starting treatment.
Contraception It is not advisable to become pregnant or father a child while taking this treatment, as the developing foetus may be harmed. It is important to use effective contraception while taking these drugs, and for at least a few months afterwards. Again, discuss this with your doctor.
Loss of periods in women Due to the effect of chemotherapy on the ovaries you may find that your periods become irregular and may eventually stop. In some women this may be temporary, but for others it may be permanent. If your periods stop permanently this will result in menopausal symptoms such as hot flushes and sweats.
This section is based upon our Mayo chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography.
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